主動(dòng)脈病變CT診斷演示文稿

主動(dòng)脈病變CT診斷演示文稿當(dāng)前第1頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)優(yōu)選主動(dòng)脈病變CT診斷當(dāng)前第2頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈病變?cè)\斷常用方法CT，經(jīng)食管超聲，MR，主動(dòng)脈造影多排螺旋CT的發(fā)展，CTA已經(jīng)成為首選的診斷手段CTA在診斷方面，優(yōu)于DSA無創(chuàng)三維顯示管壁，周圍結(jié)構(gòu)當(dāng)前第3頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)CT掃描技術(shù)掃描范圍：主動(dòng)脈弓上3cm到兩側(cè)股骨頭水平（股動(dòng)脈）120KV，120mAs；低KV，低mAs噪音增加，但不影響診斷升主動(dòng)脈建議ECG-gateing升主動(dòng)脈假夾層：右前緣和左后緣ECG-gating增加放射劑量當(dāng)前第4頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈搏動(dòng)偽影當(dāng)前第5頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)ScannerRotationtimeCollimationTablefeedSlicethicknessSliceintervalDurationNumberofimages

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(mm/s)(mm)(mm)(s)

4-slice0.54×2.5mm3031.533667

0.84×2.5mm1931.55366716-slice0.516×1.5mm4821.22183364-slice0.3332×0.6mm×24810.8211250of100cmScanprotocolsforCTAoftheentireaortawitharangeof100cmfordifferentSiemensscanners(SomatomVolumeZoom,SomatomSensation16andsensation64)當(dāng)前第6頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)對(duì)比劑注射方案主動(dòng)脈內(nèi)密度：>200HU高濃度，高流速350mgI/ml-400mgI/ml3-4ml/s劑量：根據(jù)患者體重及掃描持續(xù)時(shí)間確定進(jìn)床速度與對(duì)比劑流動(dòng)的一致性進(jìn)床太快：遠(yuǎn)端動(dòng)脈充盈欠佳進(jìn)床過慢：錯(cuò)失動(dòng)脈內(nèi)對(duì)比劑高峰時(shí)間當(dāng)前第7頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)對(duì)比劑注射方案雙筒注射器生理鹽水沖洗減少上腔靜脈內(nèi)的條狀偽影改善對(duì)比劑拖尾效應(yīng)，減少對(duì)比劑用量增強(qiáng)對(duì)比劑的團(tuán)注效應(yīng)延遲時(shí)間：testbolusbolustracking固定延遲時(shí)間（基本廢除）當(dāng)前第8頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)圖像后處理原始斷層最重要分節(jié)分段顯示后處理圖像提示診斷MIP，MPR，VR，CPR等顯示畸形，走形：VR血管內(nèi)腔及管壁：MIP，MPR去骨和不去骨都重要當(dāng)前第9頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈解剖升主動(dòng)脈：主動(dòng)脈根部（主動(dòng)脈竇），升主動(dòng)脈主動(dòng)脈弓（無名動(dòng)脈開口-動(dòng)脈導(dǎo)管或動(dòng)脈韌帶）左側(cè)右位主動(dòng)脈弓，多伴有心臟畸形無名動(dòng)脈，左頸總動(dòng)脈，左鎖骨下動(dòng)脈（迷走）降主動(dòng)脈主動(dòng)脈弓與降主動(dòng)脈連接處：主動(dòng)脈峽部當(dāng)前第10頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈解剖胸部降主動(dòng)脈腹主動(dòng)脈腹腔干根部受韌帶壓迫常會(huì)比較細(xì)變異較多腸系膜上動(dòng)脈診斷分支閉塞時(shí)，厚MIP或VR重要腸系膜下動(dòng)脈腎動(dòng)脈檢查腎動(dòng)脈變異時(shí)，掃描范圍要廣當(dāng)前第11頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)當(dāng)前第12頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈先天變異主動(dòng)脈離斷定義：升主動(dòng)脈和降主動(dòng)脈分離分型（離斷點(diǎn)定分型）TypeA：左鎖骨下動(dòng)脈遠(yuǎn)端TypeB：左頸總動(dòng)脈遠(yuǎn)端TypeC：左頸總動(dòng)脈近端右側(cè)頸總動(dòng)脈起始可正常也可異常常見異常：起源于左側(cè)鎖骨下動(dòng)脈遠(yuǎn)端（迷走右側(cè)鎖骨下動(dòng)脈）當(dāng)前第13頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈先天變異主動(dòng)脈縮窄常見位置：左鎖骨下動(dòng)脈遠(yuǎn)端（主動(dòng)脈峽部）分型管型局限型縮窄遠(yuǎn)端，主動(dòng)脈管腔常擴(kuò)張右側(cè)迷走鎖骨下動(dòng)脈長(zhǎng)起源于狹窄遠(yuǎn)端當(dāng)前第14頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈先天變異主動(dòng)脈縮窄管型縮窄可以無癥狀，偶然發(fā)現(xiàn)癥狀：高血壓引起頭痛；遠(yuǎn)端血運(yùn)差導(dǎo)致陂行嚴(yán)重縮窄：3-5歲需手術(shù)術(shù)前CTA：顯示縮窄的部位和程度，近端升主動(dòng)脈擴(kuò)張，有無伴發(fā)的動(dòng)脈瘤，有無心臟畸形術(shù)后CTA：測(cè)量主動(dòng)脈內(nèi)徑觀察恢復(fù)情況測(cè)量時(shí)，一定要MIP重建，垂直于血管長(zhǎng)徑測(cè)量?jī)?nèi)徑比較內(nèi)徑大小時(shí)，考慮年齡增長(zhǎng)因素，一般1mm/y當(dāng)前第15頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)SagittalreformattedCTimagedemonstratingamembranousseptation(arrow)distaltotheleftsubclavianarteryinapatientwithaclassicaorticcoarctation當(dāng)前第16頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈先天變異主動(dòng)脈憩室定義：右側(cè)迷走鎖骨下動(dòng)脈起始的主動(dòng)脈彈性擴(kuò)張部位：左側(cè)鎖骨下動(dòng)脈起始遠(yuǎn)端癥狀：右側(cè)迷走鎖骨下動(dòng)脈壓迫食管引起吞咽困難當(dāng)前第17頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈先天變異右位主動(dòng)脈弓通常無癥狀常伴左側(cè)迷走鎖骨下動(dòng)脈分支與正常呈鏡像時(shí)：常伴有心臟畸形左側(cè)鎖骨下動(dòng)脈離斷時(shí)：先天性鎖骨下動(dòng)脈盜血癥（左上肢動(dòng)脈搏動(dòng)減弱）當(dāng)前第18頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)(A)AxialCTimagedemonstratingarightaorticarch(asterisk).(B)Therightcommoncarotid(blackarrow)andtherightsubclavian(whitearrow)arterieshaveseparateoriginsattheaorticarch.Thereisacommontrunk(arrowhead)oftheleftcommoncarotid(CCA)andleftsubclavian(LSA)arteries.(C)Coronalreformatimagedemonstratesasaccularaneurysmoftheascendingaorta(asterisk).TheoriginofthecommontrunkoftheleftCCAandLSAisalsoseen(arrow).當(dāng)前第19頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈瘤定義

局限性，持久性，主動(dòng)脈全層擴(kuò)張，超過正常內(nèi)徑的50%擴(kuò)張不到50%：主動(dòng)脈擴(kuò)張?jiān)騽?dòng)脈粥樣硬化：最常見感染主動(dòng)脈中膜壞死囊變當(dāng)前第20頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈瘤常見的伴發(fā)致死因素高血壓，冠心病，阻塞性肺疾病，心衰動(dòng)脈粥樣硬化動(dòng)脈瘤梭形腹部降主動(dòng)脈多發(fā)馬凡綜合癥升主動(dòng)脈，累及主動(dòng)脈環(huán)梨形升主動(dòng)脈當(dāng)前第21頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈瘤CTA部位最大徑長(zhǎng)度累及的重要血管分支內(nèi)徑大約6cm易形成夾層，破裂腹主動(dòng)脈瘤人口老齡化，發(fā)病率增加無癥狀，破裂致死率增加高危險(xiǎn)人群，建議篩查：吸煙，高血壓，男性，大于65歲，家族史當(dāng)前第22頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈瘤腹主動(dòng)脈假性動(dòng)脈瘤：醫(yī)源性最多見支架植入術(shù)下腔靜脈濾器植入術(shù)心臟移植術(shù)外傷感染破裂當(dāng)前第23頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)(A)AxialCTimageinapatientwithachronicaorticpseudoaneurysm.Thethickpseudocapsuleformedbybloodandfibrotictissueisinvadingthethoracicvertebraeresultinginboneresorption.(B)SagittalreformatCTimagedemonstratesanarrowneckconnectingtheaortaandthesacofthepseudoaneurysm(arrow).當(dāng)前第24頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈瘤主動(dòng)脈瘤破裂定義：主動(dòng)脈壁全層不連續(xù)致死率：院外，90%原因：復(fù)雜，多因素主動(dòng)脈內(nèi)徑，擴(kuò)張率，舒張壓，主動(dòng)脈壁所受的剪切力和強(qiáng)度，內(nèi)壁血栓和血管壁彈性改變等破裂位置：主動(dòng)脈后壁最常見當(dāng)前第25頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈瘤主動(dòng)脈瘤破裂CT特點(diǎn)特征性改變：造影劑外漏其他：主動(dòng)脈壁不連續(xù)與主動(dòng)脈分界不清的軟組織狀況腫塊腰大肌邊緣模糊內(nèi)臟移位當(dāng)前第26頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈瘤主動(dòng)脈瘤破裂局限性主動(dòng)脈破裂特點(diǎn)：主動(dòng)脈旁軟組織腫塊邊緣較清晰積極篩查和隨訪高危人群，在主動(dòng)脈破裂前采取措施，減低死亡率當(dāng)前第27頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)AxialCTimagedemonstratinganabdominalaorticaneurysm(AAA),whichhasrupturedretroperitoneallywithresultanthematoma(asterisk).當(dāng)前第28頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈瘤感染性主動(dòng)脈瘤發(fā)病率：0.7%-2.6%感染路徑：原發(fā)灶播散，外傷，醫(yī)源性因素與動(dòng)脈粥樣硬化性動(dòng)脈瘤相比：進(jìn)展快CT特點(diǎn)：主動(dòng)脈旁軟組織腫塊，索條影，積液當(dāng)前第29頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈瘤腹主動(dòng)脈瘤處理手術(shù)：內(nèi)徑>5cm內(nèi)徑>4.5cm,半年內(nèi)徑增加大約0,5cm當(dāng)前第30頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)AxialCTimageinapatientwithtuberculosisintheposteriorsegmentofthelowerlobeoftheleftlung.Apseudoaneurysm(asterisk)ofthedescendingthoracicaortahasdevelopedduetonecrosisoftheaorticwall.當(dāng)前第31頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)AxialCTimagedemonstratingamycoticaneurysmofthedescendingthoracicaortawithperiaorticsoft-tissuemass(arrowhead)andfluid(arrow).當(dāng)前第32頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈夾層動(dòng)脈瘤致死率高累及升主動(dòng)脈成活率低于僅累及降主動(dòng)脈患者影響因素高血壓馬綜合征，Turner綜合征，結(jié)締組織病，先天性主動(dòng)脈瓣膜缺陷，主動(dòng)脈縮窄，主動(dòng)脈瘤，主動(dòng)脈炎，妊娠，可卡因等分型Standford分型：A型和B型Debakey分型：I型，ＩＩ型和ＩＩＩ型當(dāng)前第33頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)DiagramillustratingtheDeBakeyandStanfordSystemsofclassificationofaorticdissection.

當(dāng)前第34頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈夾層動(dòng)脈瘤急性：＜２周；慢性：＞２周患者死亡多在急性期累及頸總動(dòng)脈時(shí)可引起大面積腦梗死Ｄ－二聚體和凝血酶-抗凝血酶復(fù)合物與夾層動(dòng)脈瘤形狀改變呈線性關(guān)系可以用來慢性患者的隨訪當(dāng)前第35頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈夾層動(dòng)脈瘤TypeA：并發(fā)癥：心包積液（心包填塞），胸腔積液，累及冠狀動(dòng)脈和主動(dòng)脈環(huán)致死率高，需要立即手術(shù)治療TypeB致死率低致死三聯(lián)征：低血壓/休克，無胸痛，分支受累當(dāng)前第36頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈夾層動(dòng)脈瘤TypeB一般，積極控制血壓，擇期介入治療隨訪受累主動(dòng)脈直徑易增大胸主動(dòng)脈增長(zhǎng)較腹主動(dòng)脈快大于60歲假腔內(nèi)有血流破裂，分支閉塞或變大，需緊急手術(shù)或介入治療TypeA和TypeB手術(shù)治療并發(fā)癥：分支開口受阻致供血不足

處理：主動(dòng)脈內(nèi)膜開窗術(shù)當(dāng)前第37頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈夾層動(dòng)脈瘤CT表現(xiàn)平掃，增強(qiáng)都很重要平掃鈣化的內(nèi)膜內(nèi)移管腔內(nèi)密度正常急性期，假腔高密度影需與動(dòng)脈瘤內(nèi)膜鈣化伴血栓形成鑒別管腔內(nèi)密度增高當(dāng)前第38頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈夾層動(dòng)脈瘤CT增強(qiáng)表現(xiàn)內(nèi)移內(nèi)膜片真腔，假腔真腔假腔鑒別必要性：支架必須在真腔假腔：蜘蛛網(wǎng)征(cobwebsign),鳥嘴征，兩端是盲端，易發(fā)附壁血栓真腔：與近端和遠(yuǎn)端管腔連續(xù)，外壁鈣化（慢性期，假腔外壁偶可鈣化），離心性內(nèi)膜片鈣化當(dāng)前第39頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈夾層動(dòng)脈瘤CT增強(qiáng)表現(xiàn)真腔假腔鑒別上四分之一處假腔較大（85%）內(nèi)膜片：急性期：凸向假腔（56%），平直（38%），凸向真腔（6%）慢性期：平直（75%），凸向假腔（25%）中段水平假腔大（94%）內(nèi)膜片急性期：平直（37%），凸向假腔（33%），凸向真腔（30%）慢性期：平直（67%），凸向假腔（29%），凸向真腔（4%）下四分之一處假腔大（91%）內(nèi)膜片急性期：平直（33%），凸向假腔（39%），凸向真腔（28%）慢性期：平直（100%）當(dāng)前第40頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈夾層動(dòng)脈瘤CT增強(qiáng)表現(xiàn)真腔假腔鑒別真腔：對(duì)比劑早到早走，峰值較高假腔：對(duì)比劑遲到遲走，峰值較低急性期和慢性期鑒別急性期：上四分之一處和下四分之一處，內(nèi)膜片凸向假腔慢性期：內(nèi)膜片鈣化，假腔外壁鈣化，假腔內(nèi)附壁血栓當(dāng)前第41頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)(A)AxialCTimageinapatientwithaTypeAaorticdissection.Thetruelumen(arrowhead)issmallerandofhigherdensitythanthefalselumen(arrow).(B)Coronalreformatimagedemonstratesextensionofthedissectionflapintotheinnominateandrightcommoncarotidarteries(arrow).當(dāng)前第42頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)(A)SagittalreformatCTimageinapatientwithMarfansyndromedemonstratingatypeAaorticdissectioninvolvingtheentirelengthoftheaorta.(B)AxialCTimageatthelevelofthemainpulmonaryarteryshowinginvolvementoftheascendinganddescendingthoracicaorta.Thelargercavityisthefalselumenwithalowerdensity(arrows)whilethetruelumenissmallerwithahigherdensity(arrowheads).當(dāng)前第43頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)41-year-oldmanwithacuteaorticdissection.CTscanobtainedatone-quarterdistancealonglengthofdissectedportionofaortashowsdescendingaorticdissectionflap(arrows)thatiscurvedtowardfalselumen(F).Beaksign(arrowheads)ispresentinfalselumen.Notethatfalselumenareaislargerthantruelumenarea.當(dāng)前第44頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)51-year-oldwomanwithchronicaorticdissection.CTscanobtainedatone-halfdistancealonglengthofdissectedportionofaortashowsflatdissectionflap.Falselumenbeaksarefilledwithlowattenuationthrombus(arrowheads).Faintlyvisualizedcobweb(arrows)ispresentinfalselumen(F).當(dāng)前第45頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)65-year-oldwomanwithchronicaorticdissection.CTscanobtainedatone-quarterdistancealonglengthofdissectedportionofaortashowsflatdissectionflap.Outerwallcalcification(straightarrow)ispresentintruelumen(T).Thrombus(arrowheads)ispresentinfalselumen.Curvedarrowindicatesthrombuswithinfalselumenbeak.當(dāng)前第46頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)76-year-oldmanwithchronicaorticdissection.CTscanobtainedatthree-quartersdistancealonglengthofdissectedportionofaortashowsflatdissectionflap.Outerwallcalcification(arrows)andthrombus(asterisk)arepresentinfalselumen(F).T=truelumen.當(dāng)前第47頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)59-year-oldmanwithchronicaorticdissection.CTscanobtainedatone-quarterdistancealonglengthofdissectedportionofaortashowsflatdissectionflap.Eccentricflapcalcification(arrow)ispresentalongtruelumensideofflap.Noticethatfalselumen(F)containsthrombus(arrowheads)andislargerthantruelumenatthislevel.當(dāng)前第48頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn) UnenhancedaxialCTimage(A)demonstratesdisplacementofthecalcifiedintima(arrow)whichcorrespondstotheintimalflap(arrowhead)onthecontrast-enhancedCT(B).Thetruelumen(TL)isbrightlyenhancing,whilethefalselumen(FL)ispartiallyenhancingandtoalesserdegreeduetoslowerflowandthrombosis. 當(dāng)前第49頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)65-year-oldmanwithacuteaorticdissection.CTscanobtainedatone-quarterdistancealonglengthofdissectedportionofaortashowsdissectionflapthatiscurvedtowardtruelumen.Anteriorfalselumenbeak(arrowheads)ispartiallyopacifiedandpartiallyfilledwiththrombus.F=falselumen.當(dāng)前第50頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)7.—69-year-oldwomanwithacuteaorticdissection.CTscanobtainedatleveloftransverseaorticarchshowsthatouterfalselumen(F)wrapsaroundinnertruelumen(T).Dissectionflapextendsintoinnominateartery.Notecobwebinfalselumen(arrow)andbilateralpleuraleffusions(P).當(dāng)前第51頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)(A)AxialCTimageinapatientwithanacuteTypeBaorticdissection.Therightkidneyislessenhancedthantheleftkidneyduetoslowerbloodflowthroughtherightrenalarterywhichoriginatesfromthefalselumenoftheaorta(arrow).(B)AxialCTimageinadifferentpatientdemonstratingachronicTypeBaorticdissection.Long-standingdecreasedperfusiontotheleftkidneyduetoobstructionoftheleftrenalarteryorigin(arrowhead)bythedissectionflaphascausedatrophyoftheleftkidney.Therightkidneyshowscompensatoryhypertrophy.當(dāng)前第52頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈膜內(nèi)血腫夾層動(dòng)脈瘤早期或不典型夾層動(dòng)脈瘤中膜內(nèi)滋養(yǎng)血管破裂出血，內(nèi)膜片完整，無破口急性?shī)A層動(dòng)脈瘤，13%為膜內(nèi)血腫分型：Stanford分型CT表現(xiàn)平掃：新月形稍高密度影增強(qiáng)：膜內(nèi)血腫密度多變，可高可低當(dāng)前第53頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)(A)AxialCTimageinapatientwithaTypeAIMHinvolvingtheascendinganddescendingthoracicaorta.Curvilinearhypodensitiescorrespondtotheintramuralhematoma(arrows).(B).AxialCTimageinapatientwithaTypeBIMH(arrow)withcalcifiedaorticadventitia(arrowhead).(C)AxialCTimageinapatientwithaTypeBIMHwithextensivehematoma(arrow)circumferentiallywithinthewallofaorta.當(dāng)前第54頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈粥樣硬化老年代謝性疾病，女性絕經(jīng)后進(jìn)展迅速主動(dòng)脈穿透性潰瘍（penetratingaorticulcer，PAU）粥樣斑塊侵蝕主動(dòng)脈壁內(nèi)層和彈性膜，中膜內(nèi)血腫形成可致主動(dòng)脈瘤形成或主動(dòng)脈破裂囊狀動(dòng)脈瘤多PAU引起多發(fā)生在老齡患者，動(dòng)脈粥樣硬化較重主動(dòng)脈弓和降主動(dòng)脈多見，升主動(dòng)脈少見當(dāng)前第55頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)Diagramsillustratethefourstagesintheformationofapenetratingatheroscleroticulcer:(A)aorticatheroma,(B)benignintimalplaqueulcerationcontainedintheintima,(C)medialhematomawithpotentialadventitialfalseaneurysm,and(D)transmuralrupture.當(dāng)前第56頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)主動(dòng)脈粥樣硬化PAU治療隨訪手術(shù)：適應(yīng)癥：血流動(dòng)力學(xué)不穩(wěn)定，持續(xù)疼痛，主動(dòng)脈破裂，遠(yuǎn)端栓塞，主動(dòng)脈直徑快速增大難度大，并發(fā)癥多PAUCT表現(xiàn)粥樣斑塊局部潰瘍形成，主動(dòng)脈管腔局部尖角樣突起可單發(fā)或多發(fā)當(dāng)前第57頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)Aorticchangesduetoatherosclerosisindifferentstages.(A)Aorticatheroma,(B)benignintimalplaqueulceration(whitearrow)containedintheintimaand(C)medialhematoma(whitearrow)withpotentialadventitialfalseaneurysm.當(dāng)前第58頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)外傷性主動(dòng)脈損傷主動(dòng)脈不完全破裂主動(dòng)脈完全破裂外傷性主動(dòng)脈夾層動(dòng)脈瘤外傷性主動(dòng)脈膜內(nèi)血腫當(dāng)前第59頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)外傷性主動(dòng)脈損傷CT表現(xiàn)縱隔內(nèi)積血主動(dòng)脈變形內(nèi)移的內(nèi)膜片主動(dòng)脈內(nèi)血栓假性動(dòng)脈瘤降主動(dòng)脈逐漸變細(xì)當(dāng)前第60頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)(a)CTscanshowsacrescentofperiaorticbloodsurroundingthedescendingaorta(arrow).(b)CTscanshowsacontourdeformity,compatiblewithapseudoaneurysm,neartheligamentumarteriosus(arrow).當(dāng)前第61頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)Aortictransectionina39-year-oldwomanfollowingblunttraumatothechest.(a)CTscandemonstratesbloodinthemediastinumandaroundtheaorta.Anintimalflapispresentinthedescendingaorta(arrow).(b)Onanotherscanobtainedatalowerlevel,luminaldebrisandaorticcontourirregularityarenoted.當(dāng)前第62頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)Acutebluntchesttrauma.AxialCTscans(a,b)showasmallamountofbloodintheanteriormediastinumbutanormalaorticcontour.Thesternalfracture(arrowheadinb)isthesourceofblood.當(dāng)前第63頁(yè)\共有70頁(yè)\編于星期三\19點(diǎn)(A)AxialCTimagedemonstratingacontainedtraumaticaortictr